Healthcare Provider Details

I. General information

NPI: 1497185706
Provider Name (Legal Business Name): AUDREY FENIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MEDICAL PARK DRIVE SUITE 320
COLUMBIA SC
29203
US

IV. Provider business mailing address

9 MEDICAL PARK DR SUITE 320
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 843-513-3012
  • Fax:
Mailing address:
  • Phone: 843-513-3012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberDR.0069309
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55393
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD52835
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: